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Heart Bypass Surgery Rates Drop Dramatically, Study Finds
Date:5/4/2011

s were scheduled, though some were for emergency situations such as heart attacks.

During that period, there was a 15 percent overall decrease in procedures to clear coronary blockages, the investigators found.

Most of that reduction was because of a decline in annual CABG surgeries, which dropped by 38 percent. PCI, in contrast, held mostly steady with a 4 percent dip.

When the figures were projected to the entire U.S. population, there were an estimated 130,000 fewer CABG surgeries in 2008 compared with 2001, according to the study.

Dr. Debabrata Mukherjee, chief of cardiology at Texas Tech University Health Sciences Center, said even though PCI popularity has risen (the number of hospitals offering PCI increased by 26 percent during the study period, compared to about 12 percent for CABG), technological advances have made fewer PCI surgeries necessary.

In 2003, the U.S. Food and Drug Administration approved drug-eluting stents, which come with an immunosuppressant coating that helps prevent scarring and inflammation around the stent. The improved stents, which were in widespread use by 2005, reduced the need for redoing procedures because of scarring, Mukherjee said.

Prior to the innovation, about one-third of PCI patients needed a re-do within six months, he said. "Now, 5 percent, maybe 10 percent at most, need to come back," he said. "There has been a marked decrease in repeat procedures. So even as cardiologists are taking on more complex, multi-vessel cases, the overall volume of PCI hasn't gone up."

Groeneveld raised another possibility for the decline in CABG: Interventional cardiologists can do PCI, while only cardiac surgeons do bypass surgery.

Since most people see a cardiologist who would refer them to a cardiac surgeon if necessary, it's possible some patients who might be better off getting bypass surgery are being offered PCI instead, Groeneveld said.

"My hunch is cardiologists are referring fewer
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